Enucleation is the removal of the eye that leaves the
eye muscles
The extraocular muscles, or extrinsic ocular muscles, are the seven extrinsic muscles of the eye in humans and other animals. Six of the extraocular muscles, the four recti muscles, and the superior and inferior oblique muscles, control movement ...
and remaining orbital contents intact. This type of
ocular surgery is indicated for a number of
ocular tumors, in eyes that have sustained severe trauma, and in eyes that are otherwise blind and painful.
Self-enucleation
Autoenucleation, also known as oedipism, is the self-inflicted enucleation (removal) of the eye. It is considered a form of self-mutilation and is normally caused by psychosis, paranoid delusions or drugs. Between 1968 and 2018, there were more t ...
or auto-enucleation (oedipism) and other forms of serious self-inflicted eye injury are an extremely rare form of severe
self-harm
Self-harm refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin tissues, usually without suicidal intention. Other terms such as cutting, self-abuse, self-injury, and s ...
that usually results from mental illnesses involving acute
psychosis
In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or inco ...
. The name comes from
Oedipus
Oedipus (, ; "swollen foot") was a mythical Greek king of Thebes. A tragic hero in Greek mythology, Oedipus fulfilled a prophecy that he would end up killing his father and marrying his mother, thereby bringing disaster to his city and family. ...
of Greek mythology, who gouged out his own eyes.
Classification
There are three types of eye removal:
*
Evisceration – removal of the
iris,
lens
A lens is a transmissive optical device that focuses or disperses a light beam by means of refraction. A simple lens consists of a single piece of transparent material, while a compound lens consists of several simple lenses (''elements'') ...
, and internal eye contents, but with the
sclera
The sclera, also known as the white of the eye or, in older literature, as the tunica albuginea oculi, is the opaque, fibrous, protective outer layer of the eye containing mainly collagen and some crucial elastic fiber.
In the development of t ...
and attached extraocular muscles left behind
* Enucleation of the eye – removal of the
eyeball
An eye is a sensory organ that allows an organism to perceive visual information. It detects light and converts it into electro-chemical impulses in neurons (neurones). It is part of an organism's visual system.
In higher organisms, the eye ...
, but with the eyelids and adjacent structures of the
eye socket
In anatomy, the orbit is the cavity or socket/hole of the skull in which the eye and its appendages are situated. "Orbit" can refer to the bony socket, or it can also be used to imply the contents. In the adult human, the volume of the orbit is ...
remaining. An intraocular tumor excision requires an enucleation, not an evisceration.
* Exenteration – removal of the contents of the eye socket, including the eyeball, fat, muscles, and other adjacent structures of the eye. The eyelids may also be removed in cases of
cutaneous cancers and unrelenting infection. Exenteration is sometimes done together with maxillectomy (removal of the
maxilla
In vertebrates, the maxilla (: maxillae ) is the upper fixed (not fixed in Neopterygii) bone of the jaw formed from the fusion of two maxillary bones. In humans, the upper jaw includes the hard palate in the front of the mouth. The two maxil ...
).
Indications
*
Cancer
Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
of the eye, such as
retinoblastoma
Retinoblastoma (Rb) is a rare form of cancer that rapidly develops from the immature cells of a retina, the light-detecting tissue of the eye. It is the most common primary malignant intraocular cancer in children, and 80% of retinoblastoma cas ...
and
uveal melanoma
Uveal melanoma is a type of eye cancer in the uvea of the eye. It is traditionally classed as originating in the iris, choroid, and ciliary body, but can also be divided into class I (low metastatic risk) and class II (high metastatic risk). S ...
*
Congenital cystic eye
A birth defect is an abnormal condition that is present at birth, regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can range from mild to severe. Birth def ...
* End-stage
glaucoma
Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of ...
*
Phthisis bulbi
* In cases of
sympathetic ophthalmia
Sympathetic ophthalmia (SO), also called spared eye injury, is a diffuse granulomatous inflammation of the uveal layer of both eyes following trauma to one eye. It can leave the affected person completely blind. Symptoms may develop from days to s ...
(inflammation of the eye) to prevent travel to the other eye, which, if untreated, can cause
blindness
Visual or vision impairment (VI or VIP) is the partial or total inability of visual perception. In the absence of treatment such as corrective eyewear, assistive devices, and medical treatment, visual impairment may cause the individual difficul ...
* Constant infection in a blind or otherwise useless eye
* Ocular
pythiosis
Pythiosis is a rare and deadly tropical disease caused by the oomycete '' Pythium insidiosum''. Long regarded as being caused by a fungus, the causative agent was not discovered until 1987. It occurs most commonly in horses, dogs, and humans, wit ...
and some fungal infections
* Painful, blind eye
* Severe injury of the eye when the eye cannot be saved or attempts to save the eye have failed, such as after a
globe rupture
* In a deceased person, so the cornea can be used for a living person who needs a
corneal transplant
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by Corneal button, donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating ...
by a surgical operation called
keratoplasty
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty a ...
Orbital implants and ocular prostheses
Removal of the eye by enucleation or evisceration can relieve pain and minimize further risk to life and well-being of an individual with the above noted conditions. In addition, procedures to remove the eye should address the resultant appearance of the orbit. Orbital implants and ocular prostheses are used by the surgeon to restore a more natural appearance.
An orbital implant is placed after removal of the eye to restore volume to the eye socket and enhance movement or motility of an ocular prosthesis and eyelids.
[ The eyeball is a slightly elongated sphere with a diameter of approximately 24 millimetres. To avoid a sunken appearance to the eye socket, an implant approximating this volume can be placed into the space of the removed eye, secured, and covered with ]Tenon's capsule
Tenon's capsule (), also known as the Tenon capsule, fascial sheath of the eyeball () or the fascia bulbi, is a thin membrane which envelops the eyeball from the optic nerve to the corneal limbus, separating it from the orbital fat and forming a ...
and conjunctiva
In the anatomy of the eye, the conjunctiva (: conjunctivae) is a thin mucous membrane that lines the inside of the eyelids and covers the sclera (the white of the eye). It is composed of non-keratinized, stratified squamous epithelium with gobl ...
. Implants can be made of many materials with the most common being hydroxylapatite
Hydroxyapatite ( IMA name: hydroxylapatite) (Hap, HAp, or HA) is a naturally occurring mineral form of calcium apatite with the formula , often written to denote that the crystal unit cell comprises two entities. It is the hydroxyl endmembe ...
, metal alloy,ocular prosthesis
An ocular prosthesis, artificial eye or glass eye is a type of craniofacial prosthesis that replaces an absent natural eye following an enucleation, evisceration, or orbital exenteration. Someone with an ocular prosthesis is altogether blin ...
can be placed to provide the appearance of a natural eye.[ The prosthesis is fabricated by an ]ocularist An ocularist specializes in the fabrication and fitting of ocular prostheses for people who have lost an eye or eyes due to trauma or illness.{{Cite journal , last1=Khandekar , first1=Rajiv , last2=Changal , first2=Nusrat , last3=AlRasheed , first3 ...
.[ The external portion of the ocular prosthesis is painted and finished to mimic a natural eye color, shape and luster.][ It can be removed and cleaned periodically by the individual or a care giver.][
The two part system of orbital implant and ocular prosthesis provides a stable, and well tolerated aesthetic restoration of the eye socket.][ Although vision is not restored by removal of the eye with placement of an orbital implant and ocular prosthesis, a natural appearance can result.][ The implant, along with the attached, visible ocular prosthesis, can be moved by intact extraocular muscles that will track or move simultaneously with the other eye. The eyelids are able to move and blink over the prosthesis as well.][
]
See also
*
*
References
External links
Leading conditions of eye loss
Stories of eye loss
Eye Laser treatment
{{DEFAULTSORT:Enucleation Of The Eye
Eye surgery